Another Description of BPD

These two videos provide a good description of Borderline Personality Disorder (BPD). Remember that not all nine criteria need to be present to warrant a psychiatrist's diagnosis of BPD.

I have a few comments to add. When the vlogger discusses impulsive and self-sabotaging behavior, she mentions the usual suspects, like reckless promiscuity and gambling. Another behavior that is seldom cited, but could also equally qualify, is self-described "video-game addiction." This could involve playing an online video game like World of Warcraft for hours and hours on end (e.g., 18 consecutive hours) at the expense of necessary life activities.

Also, when the vlogger discusses anger, what is mentioned is the extreme exhibition of aggression. That has been documented in diagnosed cases of BPD, but it is not the only form of intense anger that can be felt by someone with BPD. What is also possible is that the person with BPD holds everything inward and refrains from expressing the aggression, but nevertheless feels it on the inside. Anger toward another person can manifest in an extreme withdrawal of affection from that person. This phenomenon still fits the "intense, inappropriate anger" criterion for BPD. It comes with what is called "the quiet version of BPD."

Anyhow, I find these videos helpful and recommend them.

My Facebook Page on BPD

Back in March 2011 I created a Facebook page on the subject of BPD. It's "The public needs to be educated about Borderline Personality Disorder."

BPD Treatments on Oahu

Psychology Today has a website that helps readers search for therapists in their region who are specialized in treating their particular condition. I ran such a search for Oahu. To my chagrin, there is only one psychotherapist in Honolulu who lists herself as being able to treat BPD (see here). I wish there was a whole lot of psychotherapists competing to treat BPD patients. The one therapist listed also treats issues relating to gender identity.

UPDATE from July 31, 2011: Earlier I blogged about BPD treatment practices in Honolulu, and noted that within Psychology Today's index of mental health care professionals on Oahu, only one was listed as a specialist for treating Borderline Personality Disorder and gender identity issues (see here). I thought there was only one such specialist on Oahu, but there is another in Kailua.

And it turns out that there is a Dialectical Behavior Therapy (DBT) clinic on Oahu. Its website's very front page mentions that the clinic's practitioners specifically aim to treat BPD symptoms.


UPDATE from Monday, January 16, 2012: Today I found another website providing contact information for other clinics and therapists in Honolulu who provide DBT. Among those professionals, though, only one mentions having a strong focus on providing DBT.

I know that, deep down, you know that it's a good idea to return to getting the help you need. Have courage. The long-range happiness that you deserve is within your grasp; you only need to courageously commit to making it a reality. :'-)


UPDATE from Sunday, June 7, 2015:  Oh, wow; now this blog post is really outdated.  A good resource is the University Hospital of Northern Norway, also called Universitetssykehuset Nord-Norge in Tromsø, particularly the psychiatric center. What is not outdated is the importance of your long-range well-being. Regular psychiatric care is worth it for your happiness. :'-)

Additional Comments on Borderline Personality Disorder

This blog post won't be the usual integrated essay that I normally write. It is just a series of comments pertaining to BPD.


Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD, or "body dysmorphia"; or, as it is called in Norge, dysmorfofobi) is a condition in which the sufferer frequently feels a very painful or disorientating sense of alienation from one's own natural-born physical features. One can look in the mirror and think, "Who is that? This is wrong. This is all wrong." One can even see oneself as ugly, no matter how much others assure one that one is the opposite of ugly.

When 70 patients diagnosed with BPD were surveyed, 54.3 percent of them reported also having Body Dysmorphic Disorder.


Gender Identity Confusion
Moreover, this other survey was given to both patients diagnosed with BPD and psychotherapy patients not diagnosed with any personality disorder.

The applicability of various categories of identity confusion to their own lives was rated on a scale of 1-7, 1 meaning hardly applicable.

Gender identity confusion refers to frequent and distressing uncertainty over which gender one wants to be. This does not refer to someone being born one sex and always or even consistently desiring to be the opposite sex. Rather, gender identity confusion refers to persistent indecision on the matter.

When it comes to the prevalence of gender identity confusion, the average of the answers for the BPD patients was 2.42, whereas the average of the answers for the psychotherapy-patients-not​-diagnosed-with-any-person​ality-disorder was 1.66. That means that the prevalence of gender identity confusion is low for both groups. However, note that this suggests that those with BPD are 45 percent likelier to experience gender identity confusion than the general population.


Indecision on Sexual Orientation (Same Survey)
Moreover, the presence of uncertainty about one's own sexual orientation (heterosexual, homosexual, or bisexual) is low for both those with BPD and those who do not have it. However, the survey suggests that those with BPD are about 31 percent likelier to have this uncertainty than those without BPD.


YouTube Cartoon About BPD Symptoms
Here is an eccentric cartoon on YouTube that describes some of the symptoms.




Concluding Remarks
Naturally, there is nothing inherently wrong -- in either the psychological or moral sense -- about experiencing uncertainty about one's gender identity or sexual orientation. Nor should one feel ashamed about having body dysmorphia.

To the degree that one is distressed by having any of these conditions, a return to psychiatric care can be very beneficial. It's worth it. :'-)

UPDATE from Wednesday, October 19, 2011: On my Facebook page about BPD, I had a helpful exchange with someone back on March 16, 2011, on the subjects of Borderline Personality Disorder, gender identity confusion, and confusion on sexual orientation. That specific exchange is over here. Of course, it is important to bear in mind that someone confused over gender identity is not necessarily undecided on sexual orientation, and someone undecided on sexual orientation is not necessarily confused about gender identity. Moreover, someone can have BPD and not be confused in either area.

One's Outward, Public Success Doesn't Preclude a Need to Return to Psychiatric Care

Stuart K. Hayashi

There are some people who achieve a form of professional or academic success, and yet their inner, private lives are full of emotional self-sabotage that could be prevented if only they sought -- or returned to -- psychiatric care and stuck with it. Sometimes such a person might rationalize, "My very success in public proves that I don't need help!"

But if that were the case, then their public successes would prove that John Belushi, Chris Farley, Michael Jackson, Charlie Sheen, Marilyn Monroe, and my own childhood idol, innovative entrepreneur Howard Hughes, were never in need of having -- or returning to -- professional help.

In other cases, one might focus on the public enterprises in order to distract oneself from facing or acknowledging the deeper insecurities that plague him or her. But that is not tenable. In the long run, one can hide the truth, but one cannot hide from the truth. The personal demons cannot be evaded, only confronted head-on with the assistance of an expert at psychiatric care.

It's not the case that success in public can ever substitute a truly fulfilling private inner state. Both one's private and public lives are important.

One might say, "John Belushi was already great the way he was." Should that be conceded, one can still consider how much more he could have gotten out of life had he stuck with treatment enough to reach full recovery.

Consider Nina (Natalie Portman's character) in Black Swan. She strove to excel in her line of work, but her mental health -- her ability to have a true inner happiness -- went woefully neglected.

It doesn't have to be that way. Private, inner peace and long-run contentment in life can be achieved, even in the absence of public success. The inner peace that come with returning to psychiatric care is really the most important success of all. It is worth it. :'-)

Lindsay Lohan (b. 1986)

Lindsay Lohan (b. 1986) yet again

Lindsay Lohan (b. 1986) yet again

Michael Jackson (1958 - 2009)

Howard Hughes (1905 - 1976)

John Belushi (1949 - 1982)

Chris Farley (1964 - 1997)

Charlie Sheen (b. 1965)

Marilyn Monroe (1926 - 1962)

Stu-Art's Art Stu-dio

At Jan Bussieck's excellent suggestion, I am contemplating opening an art studio with a big sign saying


STU ART
__D
__I
__O


;-)

There Is More to Her Than Her Looking Like a Confident, Take-Charge Person in Public...

Of all the books I have read on BPD, the one that has most emotionally affected me is Get Me Out of Here: My Recovery from Borderline Personality Disorder by Rachel Reiland (this is a pseudonym). Almost all of the book is available for viewing on Google Books over here.

Naturally, every case of BPD is unique. The problems that Ms. Reiland wrote about in her memoir are not necessarily applicable to the case of anyone else with BPD. However, dear reader, I think it might be prudent to consider reading this book if the phenomena described sound familiar or in some ways mirror your own experiences and encounters.

Ms. Reiland is an accountant who presents a very tough exterior, coming across as someone who is emotionally impervious. Upon reading, I thought, "Oh, she's like The Terminator!" It turns out, though, that the subconscious purpose of this persona was to hide a deeply ingrained insecurity. She still felt like a vulnerable baby girl, and felt the need to put on this seemingly mature "emotionless businesswoman" front as a maladaptive method for coping with the inner pain. Bragging that one is supposedly a big-shot investor in real estate is no substitute for self-acceptance.

I was also very much struck by how, in the early stages of treatment, she had to confront her own latent misogyny. She considered women to be congenitally weak and inferior to men, and thus felt ashamed of being female and of having female anatomy.

This blog post is actually not a review of the book; you already know that I recommend it. Rather, my intention here is to quote from some of the passages that most affected me. I hope that the extent to which I am quoting excerpts falls within Fair Use. If the excerpts are too long, I will remove this post.

Regarding the online Google Books version, the sections from the printed version missing from this online version are:

* Note from the original publisher (Randi Kreger)

* Foreword by BPD expert Jerold J. Kreisman

* Acknowledgments section

* Epilogue

* Section on books and websites that have more info on BPD

* "About the Author"

* Pages that were blank anyway

Other than that, so far it looks like the rest of the entire book is on Google Books.

___


Tough Persona

On the tough, numb, emotionally invulnerable face that one presents to the outside world. Pages 193-94:

I was far more familiar with the tough half of the inner child, whom in my writings I'd dubbed Toughie or TC for Tough Chick. This was the hardened facade I had maintained for years. TC was the swaggering presence the sisters [of the Catholic school] ousted from the classroom and remained in the hallway. TC lived by an I-don't-give-a-shit credo, too tough to be hurt, too independent to care, and too streetwise to ever trust a soul. To TC, trust was an open invitation to be screwed.

TC was male in every way but one. He had somehow been trapped in a female body. He was the portrait of manhood as I saw it in my childhood, one who loathed weakness and sentiment, as my father did.

The other fragment was the vulnerable one, whom I dubbed Vulno in my writings. I was not nearly as familiar with this one, whose presence seemed to have been given life through therapy. Where TC had erected a barricade of walls in self-protection, Vulno was the antithesis, a fount of raw openness. Vulno trusted everyone and could not make sense of those who would not return such trust with love. It was as if the vulnerability itself, the willingness to be screwed over, would somehow protect her. She was ruled by emotion, always thirsting for love, seeking it everywhere with anyone and suffering great pain if it weren't forthcoming.

Vulno was intimidated by power. She would not seek it. She was content to be a follower if that would gain acceptance and love. . . .

Neither fragmented identity was admirable. Both were extremes. Neither appeared very worthy to me or, for that matter, lovable. But at least I could respect the tough side, which is, perhaps, why that side openly manifested itself far more frequently than the vulnerable one.

Misogyny

Resentment of own femininity. Pages 207-08:

[Dr. Padget, the psychotherapist:] "And because you're a woman, somehow I think you're a pushover? You're saying I think you deserve less respect?"

[Rachel:] "Yes!"

"Why can't you be a strong person and a woman, too?"

"Don't patronize me, okay? You wouldn't get it. You can say all you want to, but you don't know what it's like to be stuck being a woman. You have no idea. You're a man."

Dr. Padget redirected the focus, "What is it precisely that you hate about being a woman?"

I countered with a litany of reasons. . . .

"Boys who stuck to their guns were assertive; girls who did so were pushy little bitches. Boys were steady and strong, while girls were overemotional and oversensitive." . . .

"That's your father talking again," he sighed.

"No, not just my father. My mother too. My mother thought the same things. I know she did."

Hating One's Own Reproductive Anatomy

Disturbed by physiological reminders of her own femininity. Pages 271-74:

Here, Rachel resents herself for having her period.

"Quit using those words!" I demanded [to Dr. Padget].

"Menstrual period?"

"Damnit! You're doing it again. Quit rubbing my nose in it, will you?" . . .

"I know the shame doesn't come from you," he said gently, softening the blow. "It's sad to think that something so natural could be given such distorted connotations. You feel the shame because your parents were ashamed of your femaleness. Nature's sign of maturity became a curse you felt you had to hide. But that's not the way it's supposed to happen."

"Oh, yeah?" I asked, wounded pride still stinging. "So I guess you threw a party when your own daughter started."

"No party," he said, ignoring my sarcasm. "But I was proud."

"For having her first period?" I asked, surprised to hear the words come so easily off my tongue.

"For being a woman. For growing up."

I contemplated the notion for a minute, then asked him, "If I'd been your daughter, would you have been proud of me?"

"Of course," he replied gently, his tone soothing, bonding me to him. "A good and loving father is naturally pleased to see his daughter blossoming into womanhood. Proud to see his little girl growing up."

"Dr. Padget, did you ever talk to your daughter when she wasn't a little girl anymore? You know, about feelings? Did she ever cry in front of you?"

"Sure," he smiled. "She cried; she laughed; she got angry at me sometimes. Some things she felt more comfortable discussing with her mother, but we talked about things too."

Fragmented Personalities

Rachel talks about acting as if she has more than one personality. She summons a specific personality for a specific situation. This is not merely the case of someone behaving formally in formal situations and informal in informal situations; her demeanor changes to an extreme degree as a method of coping. Pages 97-98:

"[ . . . ] "What's wrong with me? Am I really crazy? She's taking over.' [Rachel says this to her therapist, Dr. John M. Padget.]

"Who is taking over?" he asked gently, as if to a child.

"The other one. The mean one. The one that always says terrible things and gets me in trouble. That part of me. . . ."

[ . . . ]

There's only one you, Rachel. Just one. You're fragmenting here. Dissociating."

"What does that mean?"

Dr. Padget went on to explain the terms. Fragmenting, or dissociating, occurred when a person did not have a fully integrated personality. Different aspects of the personality would emerge, depending upon the situation. It was a patchwork means of coping."

When gripped by fear, the abusive tough-acting persona would come to fend off the threat and reduce the feelings of helplessness and vulnerability. When she was overwhelmed by the need to be close to someone, the pleading, begging little girl emerged. In many situations, the adult sensibilities and rationality were present, and thus the personalities would be somewhat integrated and subdued. But in times of intense feelings, one of the other two personas would step in, overwhelming me.

It wasn't a multiple personality disorder type of dissociation, he explained, because I was always conscious, at least on some level, of what I was doing and saying. A person with multiple personality disorder, like Sybil [the protagonist of the eponymous Sally Field movie], would not have the conscious awareness I did.

But the dissociation set the stage for a fierce internal conflict as the two inner-child personae, like oil and water, battled each other. One clearly female, one clearly male.

Body Dysmorphia

Throughout the work she also ruminates over her Body Dysmorphic Disorder. This refers to one having a long-term, pathological discomfort with one's own body and natural physical features, often feeling alienated from them. As she says on page 99, "My bedroom mirror was like the fun house variety."

__


I do not want to give the impression that this book only makes one feel very negative, emotionally. Rather, Ms. Reiland documents her struggle to come to grips with her condition. It is ultimately an uplifting read.

Groundhog Day Curse Can Be Broken

Stuart K. Hayashi

In 1994, Bill Murray starred in the excellent comedic fantasy Groundhog Day. In the movie, Murray's character is cursed to keep re-living the same day, February 2, over and over again. When he wakes up every day, it's February 2 and everyone acts exactly the same. Only Murray is aware that the same disastrous events are repeating.



Murray's character is not a bad person (though some people, who do not understand him, tell him that he is bitchy); he doesn't seek to hurt anyone. However, he is caught in a dysfunctional behavioral pattern that is emotionally damaging to both himself and others. Fortunately, he finally comes to understand that he does have control over his own choices. Rather than be changed by external factors impinging upon him, Murray makes a long-term commitment to changing for the better -- choosing to celebrate life and sunny happiness. By making better choices, he is able to break the curse and end the time loop.

A similar pattern sometimes occurs with those experiencing undiagnosed, currently-untreated Borderline Personality Disorder (BPD). One with this condition can continue a pattern of anxious attachment and self-sabotage, particularly in matters of love and relationships. It starts off so happy, but then one allows one's insecurities and emotional instability to sabotage it. One can then feel so vulnerable to heartbreak that one becomes too debilitated for the relationship to progress to the next stage. Then one can emotionally withdraw from the current partner while turning a lot of attention to some other object of fixation. The process can repeat itself.

The pattern of self-sabotage can change subsequent to someone strongly choosing to change it. This does not happen overnight, of course; it is a progression of baby steps to which one maintains commitment. In the case of someone with undiagnosed, currently-untreated BPD, I do not think this can be done by sheer will alone; it also requires guidance from an expert -- a psychiatric professional. It involves training in gaining a stable sense of identity. One promising sort of treatment is Jeffrey Young's Schema Therapy.



To enter -- or return to -- psychiatric care is not easy. Nor is it easy to look for a proper diagnosis. All this takes a lot of time, energy, and work. The therapy sessions can stir up a lot of unpleasant emotions and memories. It may initially seem easier to try to repress and evade those feelings and memories. Such an evasion is untenable in the long run; one can only vanquish those haunters-of-the-mind by confronting them with the guidance of a mental health expert. In the end, truly lasting happiness can result; loving and trusting relationships can be maintained. In the end, it is worth it. What is at stake is whether one will continue living the rest of one's life in insecurity and self-image instability, or find peace with oneself and others. It is a life-saving decision. Such happiness is the single most important project or enterprise one can work on. :'-) <3